Opioid Use in Cancer Pain Management for Older Adults: Efficacy, Safety, and Individualized Treatment

Abstract

As the population ages and the number of long-term cancer survivors increases, cancer pain management in older adults has become a clinically important issue at the intersection of oncology supportive care, palliative medicine, and geriatric medicine. Opioids use in older adults requires careful balancing of analgesic benefit and safety because of age-related organ dysfunction, multimorbidity, polypharmacy, cognitive and functional impairment, and increased fall risk. This review summarizes the clinical features and management challenges of cancer pain in older adults; examines the therapeutic role and limitations of weak opioids; discusses the efficacy advantages and clinical selection of strong opioids; and outlines principles for opioid dose titration, breakthrough pain management, adverse-effect prevention, and individualized management. Current evidence suggests that weak opioids may be appropriate for selected patients with mild to moderate pain or as short-term transitional therapy. Strong opioids can provide more reliable analgesia for moderate to severe cancer pain. Opioids usage should be guided by comprehensive assessment, low starting doses, gradual dose titration, close monitoring, timely opioid rotation. Individualized opioid management may be achieved via patient stratification, individual-characteristic based opioid selection, individualized dose titration and goal-oriented multimodal and multidisciplinary care. Future studies should include older, frail, cognitively impaired, and multimorbid cancer populations to support practical, evidence-based, and individualized opioid treatment pathways.